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Chronic Female Pelvic Pain—Part 1: Clinical Pathoanatomy and Examination of the Pelvic Region
Author(s) -
Apte Gail,
Nelson Patricia,
Brismée JeanMichel,
Dedrick Gregory,
Justiz Rafael,
Sizer Phillip S.
Publication year - 2012
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/j.1533-2500.2011.00465.x
Subject(s) - medicine , pelvic pain , groin , physical examination , pelvic floor , physical therapy , pelvic floor dysfunction , endometriosis , low back pain , pelvis , enthesitis , pelvic girdle , surgery , gynecology , pathology , arthritis , alternative medicine , psoriatic arthritis
Chronic pelvic pain is defined as the presence of pain in the pelvic girdle region for over a 6‐month period and can arise from the gynecologic, urologic, gastrointestinal, and musculoskeletal systems. As 15% of women experience pelvic pain at some time in their lives with yearly direct medical costs estimated at $2.8 billion, effective evaluation and management strategies of this condition are necessary. This merits a thorough discussion of a systematic approach to the evaluation of chronic pelvic pain conditions, including a careful history‐taking and clinical examination. The challenge of accurately diagnosing chronic pelvic pain resides in the degree of peripheral and central sensitization of the nervous system associated with the chronicity of the symptoms, as well as the potential influence of the affective and biopsychosocial factors on symptom development as persistence. Once the musculoskeletal origin of the symptoms is identified, a clinical examination schema that is based on the location of primary onset of symptoms (lumbosacral, coccygeal, sacroiliac, pelvic floor, groin or abdominal region) can be followed to establish a basis for managing the specific pain generator(s) and manage tissue dysfunction.